Provider Demographics
NPI:1831425883
Name:TEENAGE MENTORING, INC.
Entity type:Organization
Organization Name:TEENAGE MENTORING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PERSIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:THEOLA
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:RCSWI
Authorized Official - Phone:954-581-8454
Mailing Address - Street 1:PO BOX 223333
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33022-3333
Mailing Address - Country:US
Mailing Address - Phone:954-581-8454
Mailing Address - Fax:954-581-8252
Practice Address - Street 1:7261 NW 16 STREET
Practice Address - Street 2:B126
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313
Practice Address - Country:US
Practice Address - Phone:954-581-8454
Practice Address - Fax:954-581-8252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency